Meta-analysis of routine calcium/vitamin D3 supplementationversusserum calcium level-based strategy to prevent postoperative hypocalcaemia after thyroidectomy

Abstract

Background The aim was to assess the effectiveness of routine administration of calcium +/– vitamin D3 compared with a serum calcium level‐based strategy to prevent symptomatic hypocalcaemia after thyroidectomy. Methods RCTs comparing routine supplementation of calcium +/– vitamin D3 with treatment based on serum calcium levels measured after total thyroidectomy, published between 1980 and 2017, were identified in MEDLINE, Embase, LILACS and Google Scholar databases. Risk of bias was evaluated using the Cochrane Collaboration tool. Risk differences were calculated by random‐effects meta‐analysis. Meta‐regression and cumulative meta‐analysis were used to explore the best therapeutic approach. Results Fifteen studies with 3037 patients were included, and seven treatment comparisons were made. Routine supplementation with calcium + vitamin D3 offered a lower risk of symptomatic (risk difference (RD) –0·25, 95 per cent c.i. –0·32 to –0·18) and biochemical (RD –0·24, –0·31 to –0·17) hypocalcaemia than treatment based on measurement of calcium levels. The number needed to treat was 4 (95 per cent c.i. 3 to 6) for symptomatic hypocalcaemia. No publication bias was found; although heterogeneity was high for some comparisons, sensitivity analysis did not change the main results. Conclusion Routine postoperative administration of calcium + vitamin D3 is effective in decreasing the rate of symptomatic and biochemical hypocalcaemia.

Association of Hypocalcemia and Magnesium Disorders With Thyroidectomy in Commercially Insured Patients

“…[28][29][30][31] In addition, the practice of routine postoperative oral calcium supplementation has been observed to mitigate the rate of short-term hypoc alcemia in some series. 22,[32][33][34][35][36][37][38] Others have proposed selective calcium supplementation based on postoperative parathyroid hormone (PTH) and calcium levels, the postoperative calcium trend, or PTH gradient (between preoperative and 1-hour postoperative levels). 33,37 Selective supplementation, although shown to be associated with higher quality of life, comes at a higher cost per patient than routine supplementation.…”

Outcome of parathyroid function after total thyroidectomy when calcium supplementation is administered routinely versus exclusively to symptomatic patients: A prospective randomized clinical trial

“…Sitges-Serra's study showed that the recovery of parathyroid function was associated with more aggressive calcium supplementation after thyroidectomy, that supports the "parathyroid splinting" theory [5]. However, some studies reported that the routine use of calcium and vitamin D may lead to overtreatment and block recovery of the parathyroid [1,4,[6][7][8][9].…”

Role of perioperative parathormone hormone level assay after total thyroidectomy as a predictor of transient and permanent hypocalcemia: Prospective study

“…In a small randomized trial of 79 patients undergoing TT, routine supplementation with oral calcium and vitamin D decreased both the incidence and severity of hypocalcemic symptoms. In a meta-analysis of 15 studies, routine adminstration of calcium and vitamin D3 after TT was associated with a lower risk of both hypocalcemic symptoms (risk difference −0.25, 95% CI -0.32 to −0.18) and biochemical hypocalcemia (risk difference −0.24, 95% CI -0.31 to −0.17) in comparison to treatment based on measured calcium levels [ 14 , 40 , 41 ].…”